described 60 cases with foetal arrhythmias: 26 cases (43%) with hydrops fetalis and 34 cases without (57%). A fetal bradyarrhythmia can fall into several types which include. In: Long WA (ed. Fetal supraventricular tachycardia (SVT) is considered the most common type of fetal tachyarrhythmia and can account for 60-90% of such cases. Strasburger JF, Cuneo BF, Michon MM, et al., Amiodarone therapy for drug-refractory fetal tachycardia, Circulation, 2004;109:375–9. Curr. Drug therapy is not needed in the vast majority of pregnant women. Wolbrette D, Treatment of arrhythmias during pregnancy, Curr Womens Health Rep, 2003;3:135–9. Zusammenfassung. Liebe Velesi, es handelt sich bei diesen fetalen Arrhythmien um kindliche Herzrhythmusstörungen. 3. Pagad SV, Barmade AB, Toal SC, et al., “Rescue” radiofrequency ablation for atrial tachycardia presenting as cardiomyopathy in pregnancy, Indian Heart J, 2004;56:245–7. Objective To determine whether M mode echocardiography can differentiate fetal supraventricular tachycardia according to the ventriculo-atrial (VA) time interval, and if the resulting division into short and long VA intervals holds any relation with clinical presentation, management, and fetal outcome. Sie haben zum Teil unterschiedliche Ursachen und demzufolge auch eine unterschiedliche Bedeutung und therapeutische Konsequenz However, IV administration of verapamil carries a risk of precipitating maternal hypotension and secondary hypoperfusion, causing foetal bradycardia, high-degree AV block and hypotension. Feasibility of long-term fECG recordings ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology 335. a maximum of 100% from about 12 p.m. until 6 a.m. Fetal arrhythmias are a rare but serious condition occurring in an estimated 1-2% of pregnancies. Exacerbating factors, such as chemical stimulants, should be identified and eliminated. The pregnant patient with arrhythmias usually seeks medical attention because of ‘palpitations’, light-headedness, shortness of breath or anxiety. Hansmann et al. Compared with other arrhythmias, the overall perinatal mortality rate is considered low at ~5-10% (particularly if there are no complications such as the development of hydrops fetalis). Trappe, M. Tchirikov, Herzrhythmusstörungen bei der Schwangeren und beim FetusCardiac arrhythmias in the pregnant woman and the fetus, Der Internist, 10.1007/s00108-008-2072-5, 49, 7, (788-798), (2008). ‘Conservative’ therapy is indicated in any patient with sustained VT and stable haemodynamics (see Figure 2). APBs in pregnant woman with structurally normal hearts are benign.10 APBs may become more frequent during pregnancy, or they may develop for the first time; many patients are worried about it.13 Patient education and reassurance is the first level of intervention of this benign condition. irregular fetal bradycardia.. Bravermann AC, Bromley BS, Rutherford JD, New onset ventricular tachycardia during pregnancy, Int J Cardiol, 1991;33:409–12. Biography of Prof. Martin Meuli, MD Operation am Ungeborenen (operation before birth) WERDVERLAG.CH (CHF 39.-) 20.05.2017 To make the right diagnosis, a 12-lead ECG is ideal. The definitive diagnosis of narrow-QRS-complex tachycardia can be made in most patients based on the 12-lead ECG and clinical criteria. Digoxin is often considered the drug of first choice. The authors concluded that various haemodynamic and neurohumoral changes associated with pregnancy play an important role in ventricular arrhythmogenesis.8 In women with well-known recurrent episodes of SVTs, 14 of the 63 patients (22%) with tachycardia in the pregnant and non-pregnant periods had exacerbation of symptoms during pregnancy.18 Similar observations have been reported by others.19,20, Shotan et al14 assessed the relationship between symptoms and cardiac arrhythmias in 110 consecutive pregnant patients without evidence of heart disease referred for evaluation of palpitations, dizziness and syncope (group G I). Cleary-Goldmann J, Salva CR, Infeld JI, Robinson JN, Verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy, J Matern Fetal Neonatal Med, 2003;14: 132–5. Hubinont C, Debauche C, Bernard P, Sluysmans T, Resolution of fetal tachycardia and hydrops by a single adenosine administration, Obstet Gynecol, 1998;92:718–20. Copel JA, Kleiman CS, Fetal echocardiography in the diagnosis and management of fetal heart disease, Clin Diagn Ultrasound, 1989;25:67–83. Bei manchen Frauen ist es dann schier unmöglich ein vernünftiges CTG zu schreiben, weil die Herzschläge so unrhythmisch sind, dass ein CTG mit der Aufzeichnung und Auszählung (Technik halt) völlig überfordert ist. Procainamide appears to be equally safe, is well tolerated and has no associated teratotoxicity, whereas the potential risk of ajmalin during pregnancy is unclear and its administration should be limited to emergencies.10, Another potential antiarrhythmic drug is lidocaine, which is not known to be teratogenic. If at any time VT becomes unstable or there is evidence of foetal compromise, DC countershock (50–100J) should be delivered immediately (see Figure 1). described three cases with hydrops fetalis due to supraventricular tachyarrhythmias successfully treated with amiodarone and digoxin or the combination of digoxin, procainamide and propranolol.40. Wellens HJJ, Atie J, Penn OC, et al., Diagnosis and treatment of patients with accessory pathways, Cardiol Clin, 1990;8:503–21. Vorgestellt wird der Fall einer 20jährigen Erstgebärenden (41. In utero, all types of arrhythmia can occur. Of the 100 patients with atrioventricular (AV) nodal re-entrant tachycardia, one had the first onset of tachycardia during pregnancy. Amiodarone is well known for its many and serious side effects for both the mother and the foetus, including hypothyroidism, growth retardation and premature delivery.40,41 There is limited experience of amiodarone during pregnancy, and treatment with this drug should be reserved for life-threatening conditions.42 Magnesium is another drug with antiarrhythmic properties, particularly in patients with torsade de pointes tachycardia due to QT prolongation. Er meinte das Hezr würde sich aber noch entwickeln! Heart. These patients were compared with 52 consecutive pregnant patients referred for evaluation of symptomatic functional precordial murmur (group G II). Des. Intrauterine death was 8.0% in foetal AFlut and 8.9% in foetal SVT (p=NS). Nakagawa M, Katou S, Ichinose M, et al., Characteristics of new-onset ventricular arrhythmias in pregnancy, J Electrocardiol, 2004;37:47–53. All rights reserved. Fetale Arrhythmien sind Rhythmusstörungen, welche in der Fetalperiode entstehen oder in dieser diagnostiziert werden. If vagal manoeuvres and/or unspecific or specific drugs are ineffective at terminating SVT, direct current (DC) cardioversion (10–50J) is well tolerated and effective at terminating the arrhythmia.4 In very few pregnant patients with otherwise untreatable tachycardia, either by drugs or by direct current energy, a ‘rescue’ radiofrequency ablation is indicated and possible, with excellent results and no serious side effects for the pregnant woman or the foetus.37, Any arrhythmia can occur in the pregnant woman and the frequency and symptomatic severity of arrhythmias may be increased during pregnancy. *Others include fetal arrhythmias, antidepressants, polyhydramnious, and Morbus Graves. In many patients with narrow-QRS-complex tachycardia, the tachycardia rate is very high (180–240bpm); therefore, after onset of the tachycardia the patient will arrive very soon thereafter in an intensive care unit for diagnosis and treatment. Pathological fetal tachycardias are defined as fetal heart rates above 180–200 bpm, but most affected fetuses have ventricular rates ranging from 220 to 300 bpm. Crosson JE, Scheel JN, Fetal arrhythmias: diagnosis, and current recommendations for therapy, Prog Pediatr Cardiol, 1996;5:141–7. Although AF and AFlut are very frequent arrhythmias in adult non-pregnant patients, AF and AFlut are unusual in the absence of structural heart disease.5 Obviously, haemodynamic, hormonal, autonomic and emotional changes related to pregnancy may contribute. Arrhythmien gehören zu den häufigsten kardiologischen Auffälligkeiten beim Feten. Management of foetal arrhythmias is very difficult and requires co-operation between different consultants (obstetrics, cardiology, neonatology). SS) die bei bekanntem hypoplastischem Links-Herz-Syndrom des Kindes spontan entbindet. Barron WM, Mujais SK, Zinamam M, et al., Plasma catecholamine responses to physiologic stimuli in normal human pregnancy, Am J Obstet Gynecol, 1986;154:80–84. Pathology. Ultrasound Diagnosis of Fetal Anomalies. In general, acute therapy of arrhythmias during pregnancy is similar to that in the non-pregnant patient. Hunter S, Robson SC, Adaptation of maternal heart in pregnancy, Br Heart J, 1992;68:540–43. Pharm. Balmer C, Fasnacht MS, Rahn M, et al., Long-term follow-up of children with complete atrioventricular block and impact of pacemaker therapy, Europace, 2002;4:345–9. reported a 25- year-old pregnant woman with persistent foetal tachycardia (rate 267bpm) and subsequent hydrops fetalis.47, The woman was treated with flecainide and digoxin and tachycardia converted to sinus rhythm. Sinus bradycardia (heart rate <60bpm) recorded during Holter monitoring (1% in G I, 2% in G II; p=NS) and sinus tachycardia (heart rate >100bpm: 9% in G I, 10% in G II; p=NS) were relatively rare, whereas there was a high frequency of sinus arrhythmias in both groups (61% in G I, 69% in G II; p=NS). Pregnancy is also related to an increased frequency of arrhythmias in previously asymptomatic patients with Wolff-Parkinson- White syndrome.35 Therefore, ajmaline 50–100mg IV over five minutes is an alternative antiarrhythmic drug in emergencies, particularly in patients with accessory pathways; this has been used for many years in non-pregnant patients with circus movement tachycardia.36 There are insufficient data regarding teratogenicity or other adverse effects to the foetus when ajmaline is used. Isolated atrial premature beats (APBs) were seen in 56% of G I and 58% of G II patients (p=NS); complex APBs (5% GI and 0% G II; p=NS) or SVT (1% G I and 6% G II; p=NS) were observed rarely. Mozo de Rosales F, Moreno J, Bodegas A, et al., Conversion of atrial fibrillation with ajmaline in a pregnant woman with Wolff-Parkinson-White syndrome, Eur J Obstetrics, 1994;56: 63–6. Some types of arrhythmias have no symptoms. There are few reports on ICD therapy during pregnancy, and these studies clearly show that ICD implantation did not negatively influence pregnancy, delivery or foetal health.46, Ventricular premature beats (VPBs) in pregnant woman with structurally normal hearts are benign and therapy is usually not necessary.10 Patient education and reassurance are the first level of intervention for this benign condition. Thieme. The description of intrauterine AFlut by Carr and McLure in 1931 is probably the first published report. Specific antiarrhythmic drugs should be avoided whenever possible in these conditions, because all commonly used antiarrhythmic drugs cross the placenta and may cause serious side effects to the foetus. Hansmann M, Gembruch U, Bald R, et al., Fetal tachyarrhythmias: transplacental and direct treatment of the fetus – a report of 60 cases, Ultrasound Obstet Gynecol, 1991;1:158–60. Hrsg. Twenty foetuses (77%) with tachyarrhythmias and hydrops fetalis survived and all 34 non-hydropic foetuses survived. Exacerbating factors, such as chemical stimulants, should be identified and eliminated. It has been reported that AV nodal re-entrant tachycardia, ectopic atrial tachycardia or atrial flutter (AFlut) are serious and threatening rhythm disorders in the human foetus.26 A foetal tachycardia of a moderate to high rate with 1:1 retrograde conduction and poor cardiac tolerance can be due to a junctional ectopic tachycardia.27 In contrast to arrhythmias with a heart rate >100bpm, high-degree AV block with persistent foetal bradycardia can occur in either normal hearts or those with structural diseases.28,29 There is a poor prognosis when high-degree AV block is associated with congenital heart disease. The preferred drug for treatment of APBs is a β1-selective agent (metoprolol). VT or ventricular fibrillation (VF) was not recorded in any of the patients.14. fetal supraventricular tachycardia (SVT) most common fetal tachyarrhythmia: accounts for 60-90% of cases; has a typical ventricular rate of ~230-280 beats per minute (bpm) 4; often associated with an accessory AV conduction pathway; fetal atrial flutter. Fetale Chirurgie bei Spina bifida Möhrlen U., Meuli M. In: Spina bifida. Although sustained (duration >30s) VT is rare in pregnant women, there are some reports that VT (when occurring) originates in the patient with a normal heart mainly from the right ventricular outflow tract.21 Idiopathic left VT also occurs in pregnant patients with structurally normal hearts. 2007;93 (10): 1294-300. Fetal bradyarrhythmia refers to an abnormally low fetal heart rate (less than 100-110 beats per minute 3,7) as well as being irregular, i.e. Although several studies have shown some adverse effects (increase in myometrial tone, decrease of placental blood flow, foetal bradycardia), its use during the early stages of pregnancy is not associated with a significant increase in the incidence of foetal defects.4 Class III antiarrhythmic agents (sotalol, amiodarone) are very effective drugs in patients with ventricular tachyarrhythmias. H.J. Thomas Kohl is Chief of the German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT) at the University Hospital Mannheim, Germany. Meine Hebamme hatte diese bei unserer … In contrast, β2-blocking agents are associated in some cases with reduced utero–placental perfusion and/or foetal growth retardation, and should not be given.39. Fasnacht MS, Günthard J, Fetale Kardiologie beinhaltet nicht nur fetale Echokardiographie, Pediatrica, 2004;15:27–9. Beta-blocking agents readily cross the placenta and could, in large doses, cause a relative foetal bradycardia. 48 The incidence of hydrops fetalis was similar in those with AFlut or SVT (38.6 versus 40.5%; p=NS). In AF/AFlut with well tolerated haemodynamics, quinidine has the longest record of safety in pregnant woman for chemical cardioversion; however, other class Ia/Ic antiarrhythmia drugs are also safe for short-term use.10. Fetal tachycardia is an abnormal increase in the fetal heart rate. However, special consideration should be given to potential teratogenic and haemodynamic adverse effects on the foetus. J Ultrasound Med. Published content on this site is for information purposes and is not a substitute for professional medical advice. Krapp M, Kohl T, Simpson JM, et al., Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia, Heart, 2003;89:913–17. Check for errors and try again. Ishii K, Chiba Y, Sasaki Y, et al., Fetal atrial tachycardia diagnosed by magnetocardiography and direct fetal electrocardiography. Among these arrhythmias, supraventricular premature beats were present in 79%, atrial fibrillation (AF) in 2%, SVT in 15% and AV blocks in the remaining 4%. Auszug aus Kinder- und Jugendarzt – Zeitschrift des Berufsverbandes der Kinder- und Jugendärzte e.V. Zu den sog. There is a 1-to-1 atrioventricular conduction. In pregnant women with maternal and/or foetal arrhythmias, therapeutic strategies should be based on interdisciplinary co-operation (obstetrics, cardiology, neonatology). Die Herzvorhöfe beginnen zu „flimmern“, d.h., ihre geordn: Pressemitteilung: Vorhofflimmern behandeln Trappe HJ, Amiodarone, Intensivmed, 2001;38:169–78. Ventricular tachycardia (VT) is rarely observed during pregnancy: Nakagawa et al.8 studied 11 pregnant woman who experienced new-onset ventricular arrhythmias during pregnancy. In addition, verapamil is capable of causing foetal bradycardia, high-degree AV block and hypotension. Rhythm abnormalities of the fetus. Supraventricular tachycardia in the fetus: conservative management in the absence of hemodynamic compromise. Rotmensch HH, Elkayam U, Frishman W, Antiarrhythmic drug therapy during pregnancy, Ann Intern Med, 1983;98: 487–97. Radcliffe Cardiology is part of Radcliffe Medical Media, an independent publisher and the Radcliffe Group Ltd. Facchini M, Bauersfeld U, Fasnacht M, Candinas R, Mütterliche Herzrhythmusstörungen während der Schwangerschaft, Schweiz Med Wochenschr, 2000;130:1962–9. 1997;16 (7): 459-64. Auflage. During pregnancy, both drugs are of limited value: sotalol appears to be relatively safe, although there is a 3–5% risk of developing polymorphic or torsade de pointes tachycardia (see Figure 3). Julkunen H, Kaaja R, Siren MK, et al., Immune-mediated congenital heart block (CHB): identifying and counselling patients at risk for having children with CHB, Semin Arthritis Theum, 1998;28:97–106. J Clin Ultrasound 16:643–650 PubMed CrossRef Google Scholar Strasburger JF, Huhta JC, Carpenter RJ, Garson A, McNama-ra DG (1986) Doppler echocardiography in the diagnosis and management of persistent fetal arrhythmias. With this in mind, a successful pregnancy, for both mother and foetus, can usually be the result. Da hat er eine FATALE ARRHYTHMIE festgestellt! Premium Drupal Theme by Adaptivethemes.com. In addition, in cases of foetal ventricular tachyarrhythmias, class I and class III antiarrhythmic agents have been advocated.6,13 Recently, Anderer et al. Beta-blocking agents readily cross the placenta and could, in large doses, cause a relative foetal bradycardia. „adverse effects“ bei Ungeborenen bzw. 2 Mongiovì M, Pipitone S. Supraventricular tachycardia in fetus: how can we treat ? Chow T, Galvin J, McGovern B, Antiarrhythmic drug therapy in pregnancy and lactation, Am J Cardiol, 1998;82:58I–62I. Neither supraventricular nor ventricular tachyarrhythmias are uncommon during pregnancy.1,2 When they are diagnosed, patients, relatives and physicians are frequently worried about ectopic beats and sustained arrhythmias.3,4 One should question whether arrhythmias should be treated in the same way as they would be outside pregnancy because all commonly used antiarrhythmic drugs cross the placenta.5 The pharmacokinetics of drugs are altered in pregnancy and blood levels need to be checked to ensure maximum efficacy and avoid toxicity.6–8 The major concern about antiarrhythmic drug therapy during pregnancy is the potential adverse effects on the foetus. Mein Arzt hat heute in der 25.SSW einen Ultraschall gemacht! Isolated ventricular premature beats (PVCs) were recorded in 49% of G I and 40% of G II patients (p=NS), whereas the incidence of multifocal PVCs was higher in G I (12%) than in G II patients (2%; p<0.05).